Abstract: Cadmium is a heavy metal which accumulates in the body and affects our health. In order to control the amount we consume, the EU has set maximum permissible levels for different foods. A regulation specifying maximum levels of cadmium in cocoa and chocolate products came into force in January 2019 and similar regulations are being developed by other countries. In comparison to other cacao growing regions such as Africa and Asia-Pacific, some countries of Latin America and the Caribbean (LAC) are particularly impacted by worrying levels of cadmium in cacao beans that are a concern for the manufacturers of high-cacao content products. In this context, there is a pressing need to identify solutions that reduce cadmium levels in cacao beans and provide mitigation solutions at key processing stages in the value chain. This review presents the status of research on sources of cadmium contamination in soils, soil properties that affect cadmium bioavailability, physiological mechanisms and varietal differences in cadmium uptake by the cacao tree and the consequence of post-harvest processes. It presents potential mitigation solutions applicable to cacao that have been investigated through trials or considered by the research community. The review also includes information on ongoing research projects to gain a better understanding of the direction of research and potential gaps to be filled. This work was coordinated by Bioversity International and the Development Bank of Latin America (CAF) through the Latin American Cacao Initiative (ILAC). We thank all the institutions and individuals that provided information concerning research on cadmium and cacao and contributed to the review. We hope that this document is useful to understand the status of knowledge on this complex issue and guide future investments and collaboration to urgently provide solutions for stakeholders and particularly smallholder producers in LAC that are the most impacted.